Price cuts increase appeal of drug-coated stents

MUNICH (Reuters) - Drug-coated stents, sales of which tumbled two years ago on safety concerns, are becoming a more attractive prospect again -- helped, in part, by lower prices.

"A positive effect of this saga is a major reduction in price," Carlo Di Mario, a cardiology professor at the Royal Brompton Hospital and Imperial College in London, said on Sunday.

Coronary stents are tiny wire-mesh tubes used to prop open clogged heart arteries. Initially, drug-coated versions were hailed by doctors because of their ability to prevent arteries renarrowing, as often happens with bare metal ones.

But their use fell sharply following fears aired at a European Society of Cardiology (ESC) meeting in 2006 about late stent thrombosis -- the small but deadly risk of blood clots forming inside the devices a year or more after implantation.

Some of the alarm generated in 2006, however, has since proved unjustified, Di Mario said, and the balance of evidence showed that drug stents were a good option for many patients.

While late stent thrombosis rates were higher in drug-coated stents, this was not translated into an increase in mortality or heart attacks, he told reporters at the 2008 ESC congress.

The most likely reason for this was that problems associated with renarrowing of arteries were not as benign as opponents of drug stents had claimed, he said.

NEW GUIDLINES

The ESC -- the overarching body for Europe's cardiologists -- is now in the process of drawing up new guidelines on best use of drug stents, which will be published shortly in the European Heart Journal.

In the meantime, Di Mario said the premium charged for drug stents over older bare devices had tumbled to below 400 euros ($590) in almost all European countries, from 800 to 1,000 a year ago.

"The sharp fall in price challenges old cost-effectiveness analyses and makes the policy of rationing DES (drug-eluting stents) based on cost considerations outdated," he said.

Stents are a multibillion-dollar business for companies like Boston Scientific and Johnson & Johnson, who make the biggest-selling devices, and are growing in importance for newer players like Medtronic and Abbott Laboratories.

Britain's cost-effectiveness watchdog NICE -- the only regulatory body which has issued a specific recommendation -- ruled in July that drug stents could continue to be used within Britain's state health service for high-risk patients, but only if the price premium to bare metal ones was under 300 pounds ($550).

The National Institute for Health and Clinical Excellence backs drug when a coronary artery is less than 3mm in diameter, or the section of the artery to be treated is longer than 15mm. Such lesions are particularly tricky to treat. (Editing by David Holmes)